1. Click to edit subtitle State Public Health Laboratory Bioterrorism Capacity Norman Crouch, PhD Director, Public Health Laboratory Minnesota Department of Health Chair, Emergency Preparedness & Response Committee Association of Public Health Laboratories February 24, 2005 CDC Public Health Preparedness Conference 2005

2. Objectives  To report results from APHL's 2004 Bioterrorism Laboratory Preparedness Survey  To describe improvements and remaining gaps in public health laboratory capability and capacity  To describe the current state of public health laboratory preparedness  To highlight the need to sustain funding for bioterrorism laboratory preparedness activities

3. Method  APHL surveyed 50 states, DC, and 4 territories  52 responses received (all 50 states, DC, and Puerto Rico)  Reflects bioterrorism capability and capacity as of August 31, 2004  Includes activities from January 2003 through August 2004

4. Data  Funding and benchmarks  Workforce  Facilities and biosecurity  Equipment and supplies

5. Data  Smallpox preparedness  Training, laboratory connectivity, and integration  Transportation and courier service

6. FY00-FY04 Public Health Lab Bioterrorism Funding

7. Funding and Benchmarks  Federal and state funds cut  22 labs had average reduction of 12%  5 labs received funding from DOJ  25 labs indicate having designated funds for testing of food after a recognized intentional contamination

8. 2004 Bioterrorism Funding for Public Health Labs Total = $97,873,701 million

9. Laboratory Response Network (LRN) CDC and USAMRIID Labs Formerly Level B/C Labs Formerly Level A Labs

10. Chemical Testing Capability Level 1 62 labs Level 2 41 labs Level 3 5 labs CDC 1 lab Level 1+2 Activities Mustards Nerve Agents Level 1 Activities Cyanide Toxic Metals Competency in Collection & Shipment of Clinical Samples Comprehensive Response Plan

11. Public Health Laboratories: Backbone of the LRN  Testing of clinical and environmental samples  Over 25,000 “unknown” samples tested  90% environmental samples  Threat letters, powders, unknown packages, food, and samples from the Postal Service  Validation of new protocols  Training and coordination of sentinel labs

12. Public Health Laboratories: Backbone of the LRN  Coordination with epidemiologists  Coordination with public health response teams  Coordination with law enforcement

13. Workforce  Over 132 new employees hired  States lost highly skilled laboratorians  Recruiting pool is dismal  Additional staff needed for all areas

14. Facilities and BioSecurity  25 states lack triage facilities  46 states have BSL-3 suites  70 additional BSL-3 suites needed  Many labs have upgraded security systems  Many labs continue to enhance their facilities

15. Number of BSL-3 Suites

16. Equipment and Supplies  Upgrade and purchase new instruments  Adopt new technologies  34 Lack Luminex Technology  LRN Reagents  Much needed national repository of reagents to support LRN laboratories testing capacity

17. PCR Instruments

18. Smallpox Preparedness 50 labs have rapid detection of VZV 19 labs have a validated smallpox PCR assay Gaps: Electron microscopy (EM) facilities PCR assays for other look-alike diseases Herpesviruses Enteroviruses.

19. Training and Laboratory Connectivity  49 labs sponsored sentinel training  Total of 717 courses  Over 9,000 laboratorians trained  Training covered rule-out testing, packaging and shipping, and biosafety guidelines

20. Training and Laboratory Connectivity  42 labs have a BT Training Coordinator  51 labs maintain a sentinel lab database  44 labs have conducted capability assessments of sentinel laboratories

21. Transportation and Courier Service  28 states have a intra-state courier system  16 states provide full-state coverage for all types of specimens

22. Gaps  Need for national guidelines to triage unknown samples  Need to address environmental sampling and testing of chemical and biological agents  Need for a National Repository of Reagents for the LRN

23. Gaps  Need federal commitment to invest more in the education and training of a skilled public health laboratory workforce  Need continued investments in public health laboratories  Need sustained funding to ensure national readiness

24. Resources  www.aphl.org www.aphl.org  www.bt.cdc.gov www.bt.cdc.gov

25. Questions